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A light at the end of Evan Thomas’ 63-year fight with gender dysphoria

Evan Thomas' lifelong fight to outwardly resemble his inner sense of being a man saw major relief this week.

Evan Thomas' lifelong fight to outwardly resemble his inner sense of being a man saw major relief this week. The American Civil Liberties Union

For as long as he could remember, Evan Thomas has always felt he was supposed to have been born a man.

As a child he always dressed like a boy. Later, when he went to work for Johns Hopkins University as a Ph.D. in behavioral neuroscience, he resented the pressure to wear skirts to work so much that he quit his prestigious research job after just two years.

A mid-life career change to woodworking led Thomas to open a small furniture restoration business in St. Paul, which he ran for 10 years until the Great Recession forced its closure. Mounting depression related to his gender identity kept him from ever coping with the loss.

Thomas finally sought help in 2013, at the age of 60. Diagnosed with gender identity disorder, he signed up for hormone replacement therapy and began to live as a man as fully as he could by adopting a man’s name and changing his gender on his driver’s license, passport, house and car titles, and credit cards.

The testosterone therapy soothed some depression and anxiety, but his breasts were a constant source of distress. So Thomas used constrictive bindings to forcibly flatten his chest.

Long-term binding can deform the rib-cage and lead to yeast infections under the breasts. It also prevents deep breathing. Thomas developed multiple chest infections and bronchitis as a result, which forced him to stop wearing binders while he recovered – compounding his depression.

In 2015, Thomas’ doctor recommended that he get breast reduction surgery. But Medical Assistance, Minnesota’s Medicaid program for low-income people, denied coverage. State law was abundantly clear: “Sex reassignment surgery is not covered.”

Medical Assistance hasn’t always had this ban.

Surgery for gender dysphoria is almost universally considered “medically necessary.” Untreated, it can lead to serious psychological problems and the fatal outcome of depression: suicide. As a result, the federal Medicare program and private insurers cover sex-reassignment operations, and the Minnesota Supreme Court ruled in 1977 that the Department of Human Services had no good reason to exclude coverage.

For the next 20 years, the state covered transgender people without problem.

It wasn’t until 1998 that the legislature voted to cancel funding for the surgery. At the time, Medical Assistance was paying for three surgeries a year on average, at a price of about $7,500 each. Lawmakers specifically avoided saying that the surgeries were not medically necessary, and acknowledged that the cost to the state was not much. Instead, they argued that they were something that certain taxpayers opposed in principle.  

Last December, the American Civil Liberties Union and OutFront Minnesota helped Thomas sue the Department of Human Services. They successfully argued that because hysterectomies, mastectomies, and other transition-related surgeries are covered for non-trans people, it was discriminatory to deny them only to people like Evan Thomas.

On Wednesday, the Ramsey County District Court declared Medical Assistance’s blanket ban void and unenforceable.

"I'm so happy we've won," Thomas said. "The judge's ruling is a forceful statement that transgender people deserve equal treatment under the law. Right now, when we're suddenly facing a path that's so much rougher than it looked a few days ago, this victory looks even more important, and I'm proud to have been part of this case."

He's planning to undergo surgery in the next few weeks.